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Ethnic differences may substantially influence the morphological characteristics of the ascending aorta, with potential implications for clinical assessment and management of aortic dilatation. This systematic review evaluated the impact of ethnicity on ascending aorta diameter and dilatation rates, highlighting the need for more tailored, ethnicity-specific care in cardiovascular practice. We identified 11 studies that measured ascending aorta dimensions using transthoracic echocardiography (TTE), computed tomography (CT), or magnetic resonance imaging (MRI). Most investigations focused on Asian, Caucasian, African American, and Hispanic populations. Data extraction revealed notable variability in baseline aortic diameters across ethnic groups. Some studies found no significant differences between Asian and Caucasian participants, whereas others reported consistently larger diameters in Chinese ethnicities compared to Caucasians and smaller diameters in African American groups. One investigation, for instance, showed that Chinese participants had ascending aorta diameters approximately 1.5 mm larger than their Caucasian counterparts. Dilatation rates also diverged: one study observed that non-White race was linked to earlier or more rapid aortic root dilation in younger populations. At the same time, another reported that Vietnamese individuals had nearly twice the annual growth rate of ascending aorta dilatation when compared to other ethnicities. Available data on prevalence varied, with some studies suggesting ascending aorta dilatation ranged from about 1.2% to 7.5% in Caucasians, 0.9% to 6.4% in African Americans, and 0.8% to 5.9% in Asians. These findings potentiate the role of ethnicity in shaping aortic dimensions, possibly through a combination of genetic predisposition, environmental factors, and lifestyle influences. Incorporating ethnic background into risk stratification may improve the accuracy of clinical assessments and help guide personalized management strategies for ascending aorta dilatation. Future research should address heterogeneity in measurement techniques, more consistently defining ethnic groups, and explore long-term outcomes to clarify whether these observed morphological differences translate into variations in morbidity and mortality., Competing Interests: Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Ansari et al.)

Background The common chronic condition known as irritable bowel syndrome (IBS) lacks any visible anatomical, biochemical, or pathogenic cause. IBS significantly strains healthcare systems by sending a considerable number of patients to gastrointestinal clinics. Objective The present study investigated the knowledge, awareness, and prevalence of IBS among a sample of the Saudi community. Methods The current cross-sectional investigation was carried out from January 2, 2024, to March 15, 2024, using an electronically distributed questionnaire. IBM SPSS Statistics for Windows, Version 26 (Released 2019; IBM Corp., Armonk, New York, United States) was employed for statistical analysis. Results The study included 1,008 participants (655, 65% females and 353, 35% males). Most individuals (421, 42%) were from the age group of 18-30 years. Among participants, the prevalence of IBS was 31.8% (n=320). Regarding IBS knowledge, 42.2% (n=425) had low knowledge scores, 38.6% (n=389) had moderate knowledge scores, and only 19.2% (n=194) had high knowledge scores. The majority of respondents (886, 87.9%) believe that IBS affects QoL. Most participants (885, 87.8%) had good knowledge of the common symptoms of IBS. Additionally, 85.1% (n=858) of respondents recognized the psychological and emotional effects associated with IBS. Younger participants (under 20 years old) and single participants had significantly lower knowledge scores than their comparable groups (p<.001). Female participants had a higher percentage of high knowledge scores (13.4%) than males (5.9%) (p=.002). Conclusion The current study's findings showed that participants' knowledge of IBS was inadequate. Around one-third of the participants suffered from IBS. Younger, unmarried individuals and females had different knowledge scores than their counterparts. The study's findings imply that further education and awareness campaigns are needed to improve understanding of IBS., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Research Ethics Committee of King Abdulaziz University, Jeddah issued approval 718-23. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Baig et al.)

Surgical site infections (SSIs) are a known complication of laparotomies and intra-abdominal surgical operations leading to remarkable consequences on mortality, morbidity, and expenses. The study aims to assess the efficiency of irrigating laparotomy incision sites with povidone-iodine (PVI) or normal saline (NS) in diminishing the rate of SSIs in patients undergoing gastrointestinal operations for varying indications. Randomized controlled trials (RCTs) highlighting the contribution of laparotomy wound irrigation with PVI in opposition to NS in patients planned for laparotomy addressing numerous gastrointestinal issues, and their role in reducing SSI risk were obtained via searching of standard electronic medical databases. The analysis was conducted by utilizing meta-analysis principles procured by statistical software RevMan version 5.3 (Cochrane Collaboration, London, UK). The yield of medical databases exploration and inspection was 13 RCTs on 3816 patients who underwent laparotomy for different gastrointestinal operations. There were 1900 patients in the PVI group whereas 1916 patients received NS wound irrigations preceding closure of the laparotomy skin wound. In the random effects model analysis, the use of PVI for laparotomy wound irrigation was associated with the reduced risk (odds ratio = 0.54, 95% CI (0.30, 0.98), Z = 2.04, P = 0.04) of SSIs. Nevertheless, there was outstanding heterogeneity (Tau 2  = 70; chi 2  = 40.19, df = 12; P = 0.0001; I 2  = 70%) among the included studies. According to the comprehensive analysis outcomes, it has been clinically proven that the use of PVI is highly effective in reducing the occurrence of SSIs, as well as their subsequent implications., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Swaminathan et al.)

Introduction The epidemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) triggered the contagion of coronavirus disease 2019 (COVID-19), which killed many individuals globally. The Pfizer BioNTech vaccine was the first messenger ribonucleic acid (mRNA)-based vaccine that boosted immunity against various adverse reactions. The objective of this study was to evaluate the frequency of Pfizer vaccine side effects among participants with and without diabetes mellitus (DM). Methods This multicenter study was cross-sectional and was performed using a non-probability consecutive sampling technique. The study duration was six months, from October 1, 2022, to March 31, 2023. A total of 750 participants who received both doses of the Pfizer vaccine were included in the study. Demographic details such as gender, age, comorbidities, preceding COVID-19 infection, and the occurrence of any local and systemic side effects of the first and second doses of vaccine were recorded. The association between local and general side effects and the presence of DM was assessed using the chi-square test. Results Of the 750 participants included in the study, 289 (77.1%) were males with diabetes mellitus (DM), and 217 (57.9%) were non-diabetic participants; however, 86 (22.9%) females had DM, and 158 (42.1%) were non-diabetic; their mean ages were 48.23 ± 16.22 and 37.56 ± 12.15 years, respectively. The most commonly occurring side effects after receiving the first dose of the Pfizer vaccine were: injection site burning in 251 (66.9%) diabetic and 254 (67.7%) non-diabetic participants. Likewise, the frequency of side effects of the second dose of the Pfizer vaccine showed that the most commonly reported side effects were: muscle pain, found in 240 (64.0%) diabetic patients and 194 (51.7%) non-diabetics, with a statistically significant association (p =0.001). Conclusion This study concluded that participants with DM had local and general adverse effects considerably more frequently than those without DM. The most frequently observed adverse effects in both diabetic and non-diabetic participants were injection site burning, rashes, muscle pain, and fever after receiving both doses of the Pfizer vaccine. Moreover, most of the side effects were minor., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Akhtar et al.)

Background Intensive care units frequently contend with infections caused by highly drug-resistant organisms, particularly Acinetobacter baumannii, Pseudomonas aeruginosa, Klebsiella pneumoniae, and Enterobacterales (CRE), which often lead to high mortality rates. Colistin (colomycin) is employed to treat infections, notably extremely drug-resistant (XDR) bacteria. Antibiotic combination treatment is a frequently used tactic in this endeavour. However, the widespread use of antibiotics in synergy could result in the emergence of resistance and a rise in side effects, such as those linked to Clostridium difficile infection. The aim of the study was to assess and contrast the clinical results of intravenous colistin monotherapy with the combination of colistin and meropenem in patients experiencing MDR bacteremia resulting from Acinetobacter Baumannii, Pseudomonas aeruginosa, Klebsiella pneumoniae, and Enterobacterales (CRE). Methods In this retrospective observational study, an analysis spanning two years, from June 2021 to June 2023, was conducted at a teaching hospital located in Karachi, Pakistan. The research involved the retrospective examination of medical records from 132 patients who had been diagnosed with MDR bacteremia. Patients were divided into two categories based on their treatment regimen, either intravenous colistin monotherapy or intravenous colistin combined with meropenem. Among the 132 patients included in the analysis, 66 underwent colistin monotherapy, while the other 66 received a combination of colistin and meropenem. The primary focus of evaluation in this study centered on the 14-day all-cause mortality, while secondary outcomes encompassed clinical success and microbiologic cure. Results The mean age of patients in both groups was comparable, and there were no noteworthy gender differences. Additionally, the distribution of infection types and the isolated pathogens showed no substantial distinctions between the two groups. The study revealed no statistically significant disparities in 14-day mortality, improvement in Sequential Organ Failure Assessment (SOFA) score, or the proportion of patients who were cured and survived between the two treatment groups. Conclusion The findings from this study lead to the conclusion that there exists no significant disparity in the efficacy of colistin monotherapy compared to the combination of colistin with meropenem in the treatment of MDR bacteremia stemming from Acinetobacter Baumannii, Pseudomonas aeruginosa, Klebsiella pneumoniae, and Enterobacterales (CRE). The results provide a basis for future research and underscore the significance of ongoing endeavors to refine antibiotic treatment strategies in response to the worldwide issue of antibiotic resistance., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Baig et al.)

Background Typically, disease-related information is available in English on the internet, and the bulk of medical research journals are likewise published in English. Therefore, in non-English-speaking countries, many people find it challenging to put that knowledge into practice. This study compared Arabic-speaking students' performance on a diabetic questionnaire presented in Arabic with their performance on the same questionnaire in English. Methodology The cross-sectional study was carried out at the King Abdulaziz University, Jeddah. Identical questionnaires in Arabic and English assessing knowledge, attitude, and practices (KAP) on diabetes mellitus (DM) were filled out by Arabic-speaking students. The English version was distributed to the same students four weeks after the Arabic version. A total of 507 students filled out the Arabic questionnaire, and four weeks later, they filled out the English version. Results Students' scores were significantly higher in the knowledge and attitudes domains ( P  < 0.001), with no significant difference observed in the practice domain on the Arabic language questionnaire compared to English. A gender-wise comparison showed that females had significantly higher knowledge scores in the Arabic and practice domains in the English questionnaires. According to the regression analysis, students were predicted to have good knowledge scores on the Arabic language questionnaire than on the English version (odds ratio [OR] = 4.537, P  < 0.001). Similarly, students on the Arabic language questionnaire showed higher scores for positive attitudes (OR = 2.703, P  < 0.001), and adequate preventative behavior (OR = 1.592, P  < 0.001) than on the English version. Furthermore, being female is linked to having good knowledge scores (OR = 1.724, P  < 0.001). Conclusions Results indicated that students' good knowledge, positive attitude, and adequate practice scores were associated with the Arabic language questionnaire than the English version. Our participants' KAP scores derived from an English language questionnaire were not up to the mark. There is a need to modify the school curriculum to increase students' English comprehension and command so they can perform better in professional courses., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Gazzaz et al.)

Massive bupropion overdose has a known association with cardiogenic shock. We describe a clinical case of a 48-year-old female who was brought to the hospital by emergency medical services after ingesting numerous psychiatric medications. Her hospital course was complicated by worsening cardiogenic shock and ventricular tachycardia storm. Transthoracic echocardiography showed left ventricular (LV) hypokinesis with an ejection fraction of 9%. Then the patient underwent placement of a percutaneous Impella CP device (Abiomed, Danvers, MA). The Molecular Adsorbent Recirculating System was started for protein-bound bupropion clearance. After 24 hours, the patient returned to an organized sinus rhythm. A repeat echocardiogram done on the next day demonstrated improved LV function, and the patient had profound clinical improvement. The case illustrates how the use of extracorporeal membrane oxygenation in combination with Impella device and Molecular Adsorbent Recirculating System was able to support the patient's recovery., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Bodker et al.)

Lance-Adams syndrome (LAS) is a rare complication of successful cardiopulmonary resuscitation, often accompanied by action myoclonus. Myoclonus may occur as generalized, focal, or multifocal movements and can include the face, trunk, and/or extremities. Only 100 cases of LAS have been reported worldwide. Here, we present the case of a 53-year-old female who had a cardiac arrest event after being admitted for posterior cervical wound dehiscence management following a posterior cervical fusion from C3-T1. The patient was successfully resuscitated but developed action myoclonus in all extremities shortly after. Anoxic brain injury and myoclonus led to debilitation and prolonged hospital stay. During her inpatient stay, she was treated with clonazepam, levetiracetam, and sodium valproate with mild improvement., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Wasey et al.)

Lisinopril is an angiotensin-converting enzyme (ACE) inhibitor that is used as one of the first-line antihypertensive medications. Necrotizing pancreatitis induced by the use of ACE inhibitors is an extremely rare occurrence. Although an uncommon risk factor, our aim is to further highlight that patients with chronic use of lisinopril can develop such complications and should be considered among the list of differential diagnoses for pancreatitis. A 53-year-old Caucasian male with a history of hypertension treated with lisinopril presented with a one-day history of nausea, vomiting, and severe epigastric pain. On physical examination, there was tenderness to palpation in the epigastric region and left lower quadrant without rebound tenderness or guarding. A complete blood count showed a slight increase in white blood cell count to 12,000 cells/mm 3  and serum lipase level was elevated at 1028 U/L. A subsequent CT scan of the abdomen with contrast revealed findings supporting necrotizing pancreatitis. The patient was treated with conservative medical management with goal-directed intravenous fluid support, early enteral feeding, and pain control. His condition resolved, and he was found doing well on follow-up visits., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, Syed et al.)

Background Severe alcoholic hepatitis is a condition with a very high mortality rate and there is a paucity of evidence regarding efficacy and safety of most available therapeutic options. The present systematic review and meta-analysis aims to assess the survival benefit of granulocyte colony stimulating factor (G-CSF) in patients with severe alcoholic hepatitis. Methods Studies involving adult patients receiving G-CSF for severe alcoholic hepatitis were searched in MEDLINE, Ovid journals, MEDLINE nonindexed citations, and Cochrane Central Register of Controlled Trials and Database of Systematic Reviews. Pooling was conducted by both fixed and random effects model. Results The initial search identified 543 reference articles; of these 24 relevant articles were selected and reviewed. Data was extracted from four studies ( n  = 136) which met the inclusion criteria. In the pooled analysis, the 90-day survival in the G-CSF group was 80.03% (95% CI = 69.93-88.49) compared to 40.92% (95% CI = 29.76-52.58) in the Standard Medical Therapy (SMT) group. At 28 days, the Model for End-Stage Liver Disease (MELD) score lowered by 4.89 (95% CI = 4.13-5.64) in the G-CSF group compared to 4.00 (95% CI = 3.25-4.75) in the SMT group. Child-Turcotte-Pugh score declined by 2.26 (95% CI = 1.90-2.63) in the G-CSF group after 28 days compared to 0.91 (95% CI = 0.59-1.23) in the SMT group. At 28 days, Maddrey Discriminant Function score lowered by 39.79 (95% CI = 34.22-45.36) in the G-CSF group compared to 12.39 (95% CI = 6.90-17.88) in the SMT group. Conclusions In patients with severe alcoholic hepatitis, G-CSF therapy resulted in significantly improved 90-day survival compared to SMT. It also demonstrated significant reduction in severity indices (Child-Turcotte-Pugh, MELD, and Maddrey discriminant function) after 28 days of treatment. There certainly is a need for further studies, including development of personalized therapeutic dosing schedules, for G-CSF administration., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2020, Baig et al.)

Background Corona virus has become a global health pandemic since its origin in Wuhan, China, in December 2019. The present systematic review and meta-analysis aims to assess gastrointestinal symptoms and liver enzymes trend in corona virus infection. Methods Pooled proportions were calculated using both fixed and random effects model. Weighted mean difference and 95% CI were calculated. Results We included 15 relevant articles in the meta-analysis (n = 3762). The pooled proportion of patients with nausea/vomiting was 7.00% (95% CI = 6.00-8.00) while that of diarrhea was 6.00% (95% CI = 5.00-7.00). Weighted mean difference of aspartate aminotransferase (AST), alanine aminotransferase (ALT) in non-severe COVID-19 patients was higher by 20.54 U/liter (95% CI = 19.95-21.13) and 21.38 U/liter (95% CI = 20.92-21.84) while that in severe patients was higher by 22.70 U/liter (95% CI = 19.09-26.45) and by 22.94 U/liter (95% CI = 20.46-25.42) respectively, as compared to general population. Pooled proportions showed ALT levels to be elevated in 16.00% (95% CI = 14.00-18.00) of patients with non-severe and 25.00% (95% CI = 20.00-31.00) of patients with severe COVID-19. Weighted mean difference of albumin and platelet count was found to be lower by 3.28 g/liter (95% CI = 3.05-3.50) and by 14.21 x 10 9 /liter (95% CI = 11.87-16.55) in non-severe patients and by 11.39 g/liter (95% CI = 10.16-12.63) and 40.70 x 10 9 /liter (95% CI = 33.62-47.77) in severe patients. Conclusions Our meta-analysis shows that patients with COVID-19 infection can present with nausea, vomiting and diarrhea in addition to elevated liver enzymes including AST, ALT and a decline in albumin and platelet count which is more marked in severe disease., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2020, Puli et al.)

In the world scenario, the advent of COVID-19 has halted every aspect of life. It influenced every field of life, including the economy, and revealed the inadequacies in all nations' healthcare systems, from the most developed to the underdeveloped countries. There is a debate about the timing of antibodies production and detection during the disease. What is the significance of reverse transcription-polymerase chain reaction (RT-PCR) viral ribonucleic acid (RNA) in symptom resolving period? In the present manuscript, we have evaluated these points., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2020, Jameel et al.)

Chronic lymphocytic leukemia (CLL) is the most common form of leukemia in the western adult population; it is also prevalent worldwide. The B cell lymphoma-2 (BCL-2) family proteins play a key role in regulating intrinsic apoptosis and, in many cancers, are the main culprits behind tumor survival and therapy resistance. Hence, the role of BCL-2 inhibitors is very beneficial in the treatment of CLL. Venetoclax is the first selective, orally bioavailable BCL-2 inhibitor. This review article discusses factors such as the pharmacokinetics, pharmacodynamics, acquired resistance to venetoclax, responders vs. non-responders in venetoclax monotherapy, and the synergistic role of venetoclax with other drugs in detail. Venetoclax is the first BH3 mimetic drug and selective BCL-2 inhibitor that has received FDA approval. This drug has proved to provide good therapeutic responses in CLL patients irrespective of the presence of adverse clinical or genetic features, including in patients with relapsed or refractory forms of CLL. We anticipate that novel combination therapies, including venetoclax and immunotherapy, will further alter the treatment landscape for patients with relapsed CLL, particularly for those with deletion 17p (del 17p) CLL, which carries a very poor prognosis., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2020, Tariq et al.)

Background With an upsurge in research in developing countries, researchers from allied sciences need to augment their skills for disseminating research work worldwide. Training workshop is one of the quick interventions which can enhance writing skills and ease research publication. Objective We designed this research to explore the perception of the faculty of different higher education institutes (HEIs) regarding manuscript writing and to assess the impact of these workshops in the improvement of cognitive capabilities of preliminary researchers in Pakistan. Methodology We conducted workshops in HEIs of Sindh, Pakistan. Contents of the workshop covered algorithm of writing manuscript and related descriptions, choice of quality journals, correspondence with the editor, and dealing with rejection. The knowledge of the participants was assessed by 15 items pre and post evaluation tests. McNamar's test assessed the significance of the change in knowledge. Kruskal Wallis test was performed to check the difference in the opinion of workshop quality among different institutes. Results A significant improvement was observed in participants' knowledge on the readers' prospects (P=0.001), the algorithm of writing (P<0.001), interpretations of results (P<0.001), and selection quality journal for publication (P <0.001). The agreement with the workshop's quality based on need, knowledge, and content was above average. Conclusion The participants' response regarding the effectiveness of manuscript writing for publication workshop was overwhelmingly positive, and there was a significant impact on the knowledge of the participants. There is a need for research training that will help for better capacity building in different HEIs of Pakistan., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2020, Hussain et al.)

Ibrutinib is a Bruton tyrosine kinase (BTK) inhibitor that has shown significant efficacy in patients with lymphoid carcinomas, mostly chronic lymphocytic leukemia (CLL). Cytomegalovirus (CMV) infection is not a common infectious complication associated with ibrutinib. To increase the clinical awareness about this rare entity, we present the first case of CMV proctitis in an immunocompromised host who was being treated with ibrutinib. An 88-year old female with a history of CLL treated with ibrutinib presented with two days of painless hematochezia. Physical examination revealed cachexia and temporal wasting; bright red blood was observed on the digital rectal examination. A complete blood count demonstrated a significant decrease in hemoglobin from her baseline. Subsequent colonoscopy revealed a circumferential rectal ulcer; biopsy of the rectal ulcer was positive for CMV immunostain. The patient was treated with intravenous ganciclovir and later transitioned to valganciclovir for a total of 21 days of treatment. Her condition resolved, and she was found doing well at the follow-up visit., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2020, Reddy et al.)

Objective To identify the frequency of misdirected patients in orthopedic outpatient clinics. Methodology This was a retrospective study done in a private hospital of Jeddah. Computer records of patients attending the orthopedic outpatient department (OPD) during the period of 2013-2017 were collected. Data were analysed using IBM SPSS version 23 (IBM Corp, Armonk, NY). Descriptive statistics are presented as frequency and percentages. Results Out of the 23435 cases, 6944 (29.6%) cases should not be seen primarily in orthopedic clinic, 13638 (58.2%) were the cases that may or may not be seen primarily in orthopedic clinic, whereas, there were 2853 (12.2%) who must be seen mainly by orthopedic specialist. Conclusion This study revealed that a huge number of patients who visited orthopedic OPD does not need primarily orthopedic consultation. So, it is recommended to direct the patients to the right specialist in outpatient clinics to avoid the unnecessary burden on orthopedic clinics. The triage of referrals or walk-in patients may help to prevent this issue., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2019, Azfar et al.)

Objective: To investigate the relationship between serum leptin and reproductive hormones in females with unexplained infertility (UI)., Methodology: It was a case-control study conducted in the Gynecology and Obstetrics Department and Infertility Clinic, Jinnah Postgraduate Medical Center (JPMC), Karachi, Pakistan. A total of 235 primary infertile females with an unidentified cause of infertility were selected from the Infertility Clinics. The patients were excluded if they were found to have polycystic ovary syndrome, endometriosis, tubal blockage, irregular menstrual cycles, hyperthyroidism, hypothyroidism, hyperprolactinemia, hyperandrogenemia, fasting blood sugar >110 mg/dl, and male factor infertility. A total of 205 healthy, fertile females were selected from the general population. The blood samples of both groups were collected on the 12th and 21st day of their menstrual cycle. Serum leptin, follicle-stimulating hormone (FSH), luteinizing hormone (LH), and E2 levels were measured. Statistical analysis was executed using the SPSS version 16 (SPSS Inc., Chicago, IL)., Results: No significant difference was observed in leptin values of fertile and UI females, 37.110±1.19 vs. 35.321±0.901. In the preovulatory phase (12th day) of the cycle, infertile subjects with body mass index (BMI) <20 and 20-24.9 had significantly higher values for leptin (p<0.05), whereas, with an increase in BMI, leptin levels were reduced in these females. Leptin was reduced further in the luteal phase of infertile females with BMI 25-30, with a significantly lower value for FSH (p<0.005), LH (p<0.005), and estradiol (p<0.005. In infertile subjects, it correlated with estradiol (r=0.501, p<0.005), BMI (r=0.903, p<0.001), and progesterone (r=0.146, p<0.05)., Conclusion: Low levels of leptin observed to have an increase in the BMI of UI females were associated with a reduced estradiol and progesterone production in the luteal phase of the cycle., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2019, Baig et al.)

Objective To evaluate the physical activity levels in individuals with low back pain (LBP) and its relationship with various demographic variables like age, gender, number of days off from work and nature of occupation. Methodology This was a cross-sectional study that was done in a private hospital in Jeddah, Saudi Arabia. Data was collected between the periods of 2017-2018. All patients who attended the orthopedic outpatient department (OPD) with LBP were included in this study and were requested to fill the Rapid Assessment of Physical Activity (RAPA) questionnaire. The gathered data were analyzed through the Statistical Package for Social Sciences (SPSS Inc., Chicago, IL), version 23. One-way analysis of variance (ANOVA) was used to compare the mean difference in RAPA scores between genders, age, occupation and number of leaves from their work.  Results Three hundred sixty patients visited the orthopedic OPD with the primary complaint of LBP, 318 (88.3%) were male whereas 42 (11.7%) were female. The study revealed that among these patients, 117 (32.5%) led sedentary while 176 (48.9%) led an underactive lifestyle. Furthermore, 246 (68.3%) patients did not do any activity that increases their muscle strength and flexibility. Conclusion The findings of this study revealed that low physical activity is prevalent in patients with LBP. Therefore, the importance of physical activity should be highlighted in order to prevent chronic diseases like LBP., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2019, Azfar et al.)

Objective To measure the frequency of depression, anxiety, and stress and its association with other variables i.e., age, gender, and off work hours among low back pain (LBP) patients attending an orthopedic outpatient department (OPD) at a private hospital in Jeddah, Saudi Arabia (SA). Methodology This is the cross-sectional study, which was done in a secondary care hospital of Jeddah, SA. Data was collected between the periods of 2017-2018. All patients who attended orthopaedic OPD with LBP were included in this study and were requested to fill the Depression, Anxiety, Stress Scale-21 (DASS-21) questionnaire. The gathered data were analyzed through the Statistical Package for Social Sciences (SPSS) version 23 (SPSS Inc., Chicago, IL). One-way analysis of variance (ANOVA) was used to compare the mean difference in depression, anxiety, and stress scores between genders, age, and number of leaves from their work. Results Three hundred sixty patients came to the orthopedic OPD with the primary complaint of LBP, 318 (88.3%) were male while 42 (11.7%) were female. The study showed that among these patients 24 (6.7%) subjects were suffering from the depression while 136 (37.8%) from anxiety and 167 (46.4%) from stress. Linear regression analysis showed that depression was negatively associated with age and stress was negatively associated with the off work because of the severity.  Conclusion In conclusion, the findings of this study revealed that LBP and mental distress are related to each other. This finding urges physicians to check and treat the mental distress in patients with LBP for a better outcome., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2019, Azfar et al.)

Background This study investigated the prevalence and association of liver transaminases in type 2 diabetes mellitus (T2DM) patients at King Abdulaziz University Hospital (KAUH), Jeddah, Saudi Arabia. Methods This retrospective, cross-sectional study was carried out on 211 T2DM patients at KAUH in 2017, and the Research Ethics Committee of KAUH approved this study. The data were analyzed on SPSS 21 (IBM Corp., Armonk, NY, US). The association of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) with several risk factors was computed by the chi-square test. The odds ratio with a 95% confidence interval (CI) was also calculated. Results The mean age of study participants was 60 ± 13.43 years; 143 (67.8%) were female while 68 (32.2%) were male. Serum AST levels were elevated in 6.16% (10.3% in males, 4.2% in females). Elevated ALT levels were found in 7.58% (11.8% in males, 5.6% in females) (Table 2). The probability of rising AST levels increased with age (OR = 2.59 for patients aged 46-65) and with male gender (OR = 2.65, CI: 0.84-8.12). Additionally, the probability of rising ALT levels increased with male gender (OR = 2.25, CI: 0.80-6.27), low-density lipoproteins (LDL-C) (OR = 2.11, CI: 0.73-6.04), and triglycerides (TG) (OR = 2.08, CI: 0.739-5.87). No statistically noteworthy association was observed between elevated levels of AST and ALT with gender, age, body mass index (BMI), glycated hemoglobin (HbA1c), TG, total cholesterol (TC), LDL-C, and high-density lipoprotein cholesterol (HDL-C) levels, smoking, or hypertension. Conclusion Higher ALT and AST levels were found in T2DM patients but with no statistically significant link between elevated levels and gender, age, BMI, HbA1c, TG, TC, HDL-C, LDL-C, smoking, or hypertension., Competing Interests: The authors have declared that no competing interests exist.

Objective This study aims at a recognition of the differences in the study habits, approach to teaching resources, and spare-time activities of medical students in the preclinical and clinical training periods at King Abdulaziz University (KAU) Jeddah, Saudi Arabia (SA). Methods Study sampling was carried out in 2017 at the Faculty of Medicine, KAU, Jeddah, SA. Students from both genders were included and further subdivided to preclinical (2 nd  and 3 rd  years) and clinical groups (4 th , 5 th , and 6 th  years). Students were asked to respond to an online questionnaire. SPSS-Version 21 (IBM Corp., Armonk, NY, US) was utilized for statistical analysis of the collected data, Results Of the 347/500 (response rate 69.4%) medical students, 85 (24.5%) were from the preclinical students (2 nd  and 3 rd  years), and 262 (64.5%) were enrolled in the clinical group (4 th  to 6 th  years of MBBS). The majority of students 330 (94.1%) were unmarried, only 17 of them, i.e., 4.9%, were married. Analysis of the data revealed that medical textbooks, essential versions of basic medical books, online resources, and online version of books were used more frequently by the clinical group as compared to the preclinical students. Teacher-provided lecture handouts and lecture notes taken during classes were being equally used by both groups. There was a significant difference in the opinion on the usefulness of different resources between both groups. Students faced difficulty in understanding the English language, observed more in the pre-clinical years as compared to relatively groomed clinical students. The preclinical group could not understand the teaching material in books due to a weaker understanding of the English language. Social media software was used for keeping both groups busy, but clinical students also used social media for academic purposes. More than half of the participants from the preclinical and almost one-third from the clinical years admitted that their teachers recommended them for relevant medical textbooks. An encouraging trend was observed in most preclinical group students: they found teaching modalities, such as problem-based learning (PBL) and other academic activities, as a trigger to promote book reading. Conclusion Our results show that the students in the clinical phase had a more methodical approach to professional studies and a difference in spare-time activities., Competing Interests: The authors have declared that no competing interests exist.

Objective The presence of good healthy behaviors among university students is imperative for their future life. This study aimed to compare positive health behaviors and state of happiness between the two genders of Bahria University (BU), Karachi, Pakistan. Subjects and methods This cross-sectional study was conducted at BU, Karachi, Pakistan. A total 813 students participated in this study. The health questionnaire, adapted from Health and Behavior Survey and the Subjective Happiness Scale, was used to assess self-reported happiness. The data were analyzed using IBM SPSS version 22. Results Overall self-reported health behaviors were found to be more prevalent in females as compared to males, but males reported a better self-reported general health (p = 0.012). Testicular and breast self-examination was not common in both genders. Smoking was found to be more common in males (p < 0.01). Males exhibited habit of regular breakfast (p = 0.013) whereas females showed a tendency to avoid food rich in cholesterol and fat (p < 0.01) and the practice of consuming food rich in fiber was found to be more prevalent among females (p < 0.01) and they showed urge to lose weight (p < 0.01). Sleep disturbance was found in both genders, more so in females (p = 0.012). Consciousness about dental hygiene was common in females (p < 0.01). As compared to the females, more males strongly believe that they are very happy in life (p < 0.01), and they make the most out of everything in life (p < 0.01). Conclusion There was a diverse response to positive health behaviors and state of happiness in both genders., Competing Interests: The authors have declared that no competing interests exist.